Holtzendorff was suffering the effects of a concussion — his first one — from the previous evening at football practice.

And there was something else.

A medical scan later revealed a small bleed in his brain, setting in motion a life-changing experience for one of Cypress' most respected football players.

The resulting journey also put a face on progressive, new concussion program in the Anaheim Union High School District: a tough defensive end nicknamed “Holtzy.”

NEW PROGRAM

Like all football players in the Anaheim district, Holtzendorff and his Cypress teammates participated in the district's new concussion program before the season.

The district rolled out the initiative during the summer after partnering with the Sports Concussion Institute (SCI), a national clinic that treats athletes with concussions from “high velocity” sports such as football and also works with the NBA's Clippers, among others.

The partnership arrived as head injuries continue to spark heavy debate in the NFL.

In late August, the NFL settled a concussion lawsuit with thousands of former players for $765 million.

The debate has trickled down to high school football.

A recent PBS “Frontline” special, “League of Denial: The NFL's Concussion Crisis,” raised the question whether football is safe at the youth and high school levels.

And this week, an NFL-funded study reported that football easily has the highest rate of concussions among high school sports and that high school football players are almost twice as likely to suffer a concussion compared to their college counterparts.

“Concussions are big in the news right now,” said Dale Miller, the certified athletic trainer for the Anaheim district who helped start Anaheim's program. “(We're) trying to be one step ahead and to be proactive and protect our student-athletes.”

The district's program features the institute leading student-athletes from “impact sports” through a 45-minute concussion education course, a computerized, cognitive baseline test for concussions and a computerized balance evaluation.

The baseline test provides valuable information used in the evaluation process for student-athletes returning to play after a concussion.

For the fall sports season, the institute estimated it baseline-tested approximately 1,300 student-athletes, which included boys water polo players.

The program will next tutor student-athletes from the winter season sports of basketball, soccer, girls water polo and wrestling.

ANAHEIM LEADS

A few other Orange County school districts also baseline test their athletes for concussions, but the Anaheim program stands out for being comprehensive.

Anaheim's partnership with SCI includes a secondary, $25,000 insurance policy free for athletes to receive care through the institute if their family insurance doesn't cover the care, said Tony Strickland, a neuropsychologist and SCI's CEO.

SCI offers the insurance coverage while the district paid approximately $15,000 for baseline testing for the school year. The district said it used safety insurance credits to pay for the baseline testing.

“We have launched the most comprehensive prevention/intervention program that I'm aware of nationally,” Strickland said. “It's all covered.”

Anaheim's move appears bold when compared to some regulations. The state, for instance, requires parents/guardians and student-athletes to receive and sign a concussion information sheet as part of their clearance for athletics.

The California Interscholastic Federation, which oversees high school sports in California, requires players suspected of having suffered a concussion be removed from the activity for the rest of the day and not return until being cleared by a health care provider.

“That's ahead of the curve,” said Dr. Robert Cantu, a clinical professor of neurology and neurosurgery at Boston University's school of medicine. “I think it's great that (their) baseline assessment is putting together some balance issues.”

Anaheim's direction also appears progressive for football.

“Twenty-five years ago when I first started, (or) 30 years ago, it was totally different,” Katella football coach Fred DiPalma said. “Now (concussions) aren't something to be messed around with so we don't. We don't say, ‘Oh, you got your bell rung.' That's out. We're saying, ‘OK, you may have something. You need to be looked at.'
”

“I think there's a lot of publicity out there that might be questionable and puts some fear into (parents),” he said. “Every once in awhile, there's an over-emphasis put on our sport.”

‘HELL WEEK'

Holtzendorff was determined to whip Cypress football's “Hell Week” in August. The annual rite of passage for Cypress football players had been challenging for him in previous summers, so he prepared by running four miles a day for two weeks leading up to camp.

Holtzendorff's motivation was high after being selected by Cypress coaches as the player to wear jersey No. 44, which is awarded annually to the senior who shows high character and strong work ethic.

The selection honors former Cypress standout Randy Teasley, who wore No. 44 in the 1970s and died in 1991.

“Holtzy” was No. 44 going into Hell Week.

“I was so excited to play my senior year,” he said. “I was in the best shape of my life.”

But during a hitting drill late in practice Aug. 14, he took a blow that changed the course of his season.

The drill required Holtzendorff, a 6-foot, 195-pound defensive end, to elude a blocker and tackle a ballcarrier.

He completed his first attempt without issue, but during the second attempt, he believes he and the ballcarrier collided helmet-to-helmet.

“Damn. That was a hard hit,” he thought.

Holtzendorff took off his helmet, rubbed his head and was set to return to the drill but practice ended. He didn't give much thought to the incident after practice.

Everything changed the next morning.

He felt disoriented while out to breakfast with his girlfriend and called his father, Matt, during a flood of emotions.

One moment he was crying, the next he was laughing. He had difficulty finishing his sentences.

“Dad, I have five or six of the symptoms they were talking about (during the concussion program),” he eventually told his father.

Holtzendorff attempted to register for classes at school later in the day but his symptoms worsened. His mother, Sheri, picked him up at school and took him to an emergency room in Los Alamitos. A scan showed a 4- or 5-millimeter bleed in his brain or a subdural hematoma.

Cantu said he encounters only a few subdural hematomas cases in high school athletics on a yearly basis during his duties as the medical director for the National Center for Catastrophic Sport Injuries Research in North Carolina. The injury, however, can be dangerous.

“It's the most common cause of death (from the trauma of playing) football,” said Cantu, author of the recently released book, “Concussions and Our Kids.”

“Subdurals, when they're very small, don't require any surgery, and yes, they almost always absorb and go away on their own.”

Holtzendorff was admitted to the hospital and stayed overnight. By the next morning, the bleeding had stopped and cleared and he was released.

“I was lucky it was a small amount,” Holtzendorff said of his bleed. “If I went in that (hitting drill) a third time before the end of practice, it probably would have gotten worse.”

SYMPTOMS WORSENED

Holtzendorff left the hospital Aug. 16 with a recommendation from his primary neurologist that he would be unable to play football for at least one month, his mother said.

His next two weeks, however, were filled with symptoms of a concussion. There were headaches, confusion and emotionally trying episodes such as team pictures Aug. 17.

“It was real stressful with my whole team there and I had to tell everybody and the coaches what happened,” he said. “I was about to break down.”

The symptoms gradually began to fade, and after a clear MRI, he was approved Sept. 16 by his primary neurologist to return to playing football with one restriction: He would have to be evaluated by the Sports Concussion Institute.

The Holtzendorffs met with SCI on Sept. 18 and soon began undergoing additional tests requested by the clinic.

Holtzendorff's parents were concerned about their son's health but shared in his hope that he could eventually return to football.

The family worked diligently toward a return. Additional tests were passed, and they pushed through frustration and confusion with insurance and testing issues.

Strickland declined to discuss Holtzendorff's case specifically because of patient confidentially, but he said, in general, concussions often bring accompanying emotions and require individualized care.

It was an emotional few weeks, and with one more test lingering and a meeting scheduled with SCI on Oct. 2, Holtzendorff was considering calling an audible.

EMOTIONAL DECISION

During an hourlong meeting at the institute's Anaheim office, Holtzendorff and his mother say they were presented additional opinions the institute gathered from consulting other neurologists.

“A lot of them recommended (that I) wait a year after impact if I was even going to consider going back to a (collision) sport like football,” Holtzendorff said.

Holtzendorff asked to speak to his mother alone in another room.

“We sat in there about half an hour crying,” Sheri said. “That's when he made that decision.”

Holtzendorff decided to end his attempt to return to football. It was a decision he had been pondering.

“I thought about it for the past month,” he said. “(A) second impact (blow) had been brought up by the doctors a few times and how dangerous it is. … To me, it wasn't worth going back for five games versus losing the rest of my life.”

Miller said concussion research is focusing on repeated blows. The PBS special focused strongly on the impact of Chronic Traumatic Encephalopathy (CTE), a neurodegenerative disease that researchers believe is triggered by repeated head trauma.

The NFL-funded high school report said most concussion symptoms disappear in about two weeks but 10-20 percent of cases feature symptoms for weeks, months or years.

“The more and more research out there now is saying we have totally underestimated the long-term effects of a concussion and continued concussions,” Miller said. “The education of concussions is going to be elevated (in the future).”

Holtzendorff, however, already knew enough to want to protect his future.

After that final appointment at SCI, Holtzendorff went home and explained his decision on a post to his Facebook page:

I wish more than anything that this was just a regular concussion but it's not. I got unlucky and had bleeding, and this changed my personality and motivation towards the sport because I am NOT the same as I was before Hell Week. The only difference isn't that I'm scared of returning to play after all this time. I am scared of 2nd impact and risking losing the chance at the rest of my life, having a family, having a career, holding my child in my arms years down the road, getting married, living life just over 5 football games my senior year. I can't do that.

Holtzendorff's parents marveled at the maturity of their son's decision. They knew how much he wanted to play as Cypress' No. 44, but in the end they saw him separate from that emotional pull.

“I'm very proud of him,” Sheri said.

Burt announced the news to the team, and Holtzendorff felt like his decision was respected.

The cheerleaders made a banner in his honor before the game against rival Kennedy on Oct. 4: “Let's go Cypress for #44 Holtzy.”

The Centurions also read his Facebook post before the game:

(I) love this sport, the atmosphere, my team and my 2nd family, but I'm doing it for the better of my future.

Anaheim's concussion program is looking after the same thing: futures.

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